Goldenseal and the common cold: The antibiotic myth

by Paul Bergner

Goldenseal today has a wide reputation as an "herbal antibiotic,"
based on scientific research and the clinical use its constituent berberine.
Table 1 shows a list of organisms which berberine can kill or neutralize
in the petri dish. When goldenseal is used topically, put directly onto
an infected wound or ulcer, the berberine or other alkaloids may have such
an effect on the microorganisms in the wound. It may have the same effect
in the mouth and pharynx, and possibly on infected gut mucosa. From research
such as this, it is enticing to conclude that goldenseal and other berberine-containing
plants taken internally act in the body the same way that pharmaceutical
antibiotics do, to kill or inhibit bacteria. However, clinical research
actually indicates otherwise.

First of all, in humans, berberine is very poorly absorbed across in
the small intestine (Bhide et al 1961). Four hundred milligrams of berberine
sulfate, the amount contained in from about 26 capsules of goldenseal powder,
causes blood levels of berberine to rise to 100 micrograms per cent. This
is only about 1/200th of the levels that kill the bacteria shown in the
accompanying table 13.2 (Bensky and Gamble 1986). Berberine itself thus
does not act as a systemic antibiotic, and goldenseal, which contains only
a small percentage of berberine cannot either, at least not due to its
berberine content. Berberine is excreted through the urine in humans (Chopra
et al 1932), so it could conceivably have some antibiotic effect in the
concentrated urine in kidney or urinary tract infections — conditions that
it was used for by American physicians of the last century.

Colds and flu

In my experience both selling herbs at retail, and seeing patients in
the clinic, not even 10% of the goldenseal use in the U.S. is clinically
appropriate. When someone pops large amounts of goldenseal "for a
cold," especially in its early stages, they are wasting both their
money and an endangered plant. People in our culture are conditioned to
think "I need an antibiotic" when they have a cold, although
neither conventional nor herbal antibiotics are appropriate for such viral
conditions. Table 3 shows the traditional medical uses of goldenseal. In
it we find not one single reference to the use of goldenseal for colds,
flu, or similar infections. Its use is limited to topical application,
including douche for vaginal infections, diarrhea and dysentery (later
stages) or as a bitter tonic or mucous membrane alterative. Traditional
physicians used goldenseal in sub-acute and chronic mucous membrane conditions,
not in acute inflammations of the same. Table 2 shows the dynamics of a
mucous membrane infection. Taking goldenseal or berberine internally will
not directly kill or inhibit bacteria or other infectious agents in most
of these conditions, unless coming in direct contact with the infected
tissue. What they will do, according to traditional herbal medicine, is
excite the mucous membranes "to unusual secretion." In doing
so, in the second and third stages of the pathology, the fresh and abundant
mucous can soothe, clean, disinfect, and heal the tissues. Taking goldenseal
too early in the process —especially in doses higher than the traditional
15 drops of tincture — can have negative effects. it may:

1) Exhaust the mucous glands, by overstimulating them, causing dry membranes.
Two to three goldenseal capsules has a distinct drying effect on the membranes.

A cold may seem to get better because of the drying effect, but it actually
inhibits the natural defenses against whatever bug has got your patient.
It may be appropriate on the third or fourth day of a cold or flu, when
there is any fear of a bacterial infection setting in. At that stage, in
smaller doses, goldenseal will restore a healthy flow of mucous to the
stagnant membranes.

Large doses

Goldenseal provides its internal benefits in small doses — 10-15 drops
of a tincture or fluid extract in a glass of water —and does its work in
a few days to a week. Larger doses or long duration can begin to cause
side effects. Here is how the homeopath Dr. Edwin Hale described the effects
of taking too much goldenseal, after many homeopathic provings in the mid-nineteenth
century:

"The increased digestive power gives way to indigestion; the increased
power of assimilation to deficient nutrition; and apparent strength to
real debility. . . . the natural secretion [of the mucous membranes] is
at first increased; then it becomes abnormal in quantity and quality. At
first, clear, white, and transparent, it becomes yellow, or thick, green,
and even bloody, and nearly always tenacious. . . . The distance traversed
by the primary mucous flux passes from simple increase of mucous, to erosion
and ulceration. Its secondary effects are exhaustion and destruction of
the glandular sources of the mucous — a condition in which the mucous surface
is dry, glazed, and its functions destroyed. (Hale 1875)

The digestive tract is especially susceptible to such effects, and individuals
who pop goldenseal for their colds are usually injuring their stomach and
intestines instead of helping their cold. This effect is consistent with
the caution in traditional Chinese medicine that bitter herbs taken inappropriately
or in too high a dose can injure "the spleen" — the intestinal
function in Western terminology.

Goldenseal and normal bowel flora

One side effect of the myth that goldenseal is an antibiotic is that
it might, like conventional antibiotics, disrupt the balance of normal
bacteria in the intestine. This action is responsible for some of the minor
or serious side effects of antibiotics. We have no evidence, either from
traditional use or from scientific experiments, that either berberine or
goldenseal can cause this problem. In fact, in one trial indicates the
opposite.

Berberine sulfate is used clinically in Asia to treat diarrheal infections.
In one double-blind placebo-controlled trial, 400 mg doses of berberine
sulfate were given orally to men with E. coli<D>-induced diarrhea.
The group receiving the berberine had a 48% reduction is stool volumes,
and 42% of the men in the group stopped having watery stools within 24
hours, compared with 20% in the control group, who received only a placebo.
The results are typical of treatment of diarrhea with berberine. This trial
is frequently cited by herbal companies as "proof" that berberine-containing
plants kill bacteria in the intestine, even though the authors of that
trial reach the opposite conclusion. They found that pathogenic bacterial
counts in the patients were unchanged (Rabbani et al 1987). Berberine in
such high doses (the equivalent of about 26 capsules of goldenseal) did
not appear to disrupt the pathogenic bacteria, much less the beneficial
ones. I first heard about this possibility in the mid-1980s. I've been
looking for a single case report of this effect ever since, and have never
heard of one.

So how does it work?

One traditional use of goldenseal is as a mucous membrane tonic. Note
that it does not have to come in contact with the mucous membranes to have
this effect. Hold some goldenseal in your mouth for a minute or two, and
you can feel the effect on the mucous membranes in your nose and sinuses.
Traditional doctors stated that goldenseal increases the secretion of the
mucous membranes. At the same time, goldenseal contains astringent factors,
which also counter that flow. Thus it was referred to as a mucous membrane
"alterative," increasing deficient flow but decreasing excessive
flow. How this happens has not been determined by science, but is thoroughly
supported by the traditional uses by some of the physicians in Table 3.
It is my opinion that goldenseal acts as an "antibiotic" to the
mucous membranes not by killing germs directly, but by increasing the flow
of healthy mucous, which contains it's own innate antibiotic factors —
IgA antibodies. This effect is unnecessary in the early stages of a cold
or flu, when mucous is already flowing freely.

Goldenseal substitutes

"Berberis acts much like hydrastis and could be employed for many
of the uses of that scarce and high-priced drug so far as the berberine
effects are concerned." (Felter 1922)

Berberine-containing herbs

Most of the research that is popularly attributed to goldenseal has
actually been into its constituent berberine. A number of other plants
contain berberine in medicinal quantities. One of them, coptis<D>
(See MH<D>, Summer 1996, volume 8, number 2) actually contains more
berberine than goldenseal. The accompanying table shows the situations
where they can best be used in place of goldenseal. All these plants, like
goldenseal, have a characteristic bitter flavor, and may be used as bitter
tonics. Don't take berberine-containing plants during pregnancy. This caution
applies to most plants containing alkaloids, including tobacco and coffee.

Potential toxicity

Rumors are circulating in scientific and regulatory circles that berberine
may be toxic. In 1996, the committee of the European Union that regulates
drugs placed Barberry (Berberis vulgaris<D>) in a table of Herbal
Drugs with Serious Risks without any Accepted Benefit because it contains
berberine. This recommendation is so out of line with the long traditional
use of barberry and other berberine-containing herbs that it must be taken
with a grain of salt. The "serious risks" may refer to animal
trials or human incidents using large amounts of isolated berberine. The
lack of "accepted benefit" may be simply because these plants
have not been studied in formal clinical trials, as is common with most
medicinal plants. I was able to find only a single report of potential
adverse effects of berberis species, berberine-containing plants, or berberine
itself in a computer search of the MEDLINE and TOXLINE databases of the
U.S. National Library of Medicine. This was a study in China that showed
that berberine sulfate is inappropriate for the treatment of newborn infants
with prenatal jaundice (Chan 1993). I assume this is not a risk for the
general public or for contemporary herbalists or general practice physicians,
because such an infant will be hospitalized in this country. It does support
traditional cautions about using berberine-containing plants in pregnancy,
however.

In a recent review of potentially hepatotoxic herbs, two French physicians
state only that barberry has been "suggested" as potentially
hepatotoxic, with no specific clinical evidence. He cites Vulto and De
Smet (1988) as a source, but states that no case has been confirmed, and
that the problem, if there is one, is rare (Larrey and Pageaux 1995). Another
trial showed that a berberis species from India protected<D> the
liver from damage by the drug acetaminophen (Gilani and Janbaz 1992).

Barberry (Berberis vulgaris<D>)

This quote at the beginning of this article doesn't come from a modern-day
herb conservationist, but from Dr. Harvey Felter in 1922. In his time,
goldenseal had already become scarce due to overharvesting in areas of
the country. The situation now, seventy five years later, is much worse,
and barberry, as a substitute is just as effective. The table below shows
some traditional uses of barberry. A tincture is usually taken. For external
applications, sores in the mouth, or eye problems, make a tea, and, in
the case of the eyes, dilute it (20 drops of the tea in a pint of water.).
Contemporary researchers have used berberine successfully to treat eye
infections. According to Felter, who was familiar with such treatments,
barberry is more effective for this than the isolated berberine alkaloid
(Felter and Lloyd 1898).

Traditional uses of barberry

Blood purifier

Indigestion

Chronic diarrhea

Jaundice

Dysentery

Laxative

Eye problems

Mouth sores, ulcers

Fevers

Bitter tonic

Oregon grape root (Mahonia aquifolium, Berberis aquifolium<D>)

Ellingwood classifies Oregon grape not as a goldenseal substitute, but
as an echinacea substitute. He calls it an antiseptic alterative.<D>
Historically it has been used, like echinacea, for "bad blood,"
although it does not have the high reputation that echinacea does for this.
It is probably not an immune-stimulant. Felter, on the other hand, did
consider it a goldenseal substitute and said of it:

"Like goldenseal, Berberis aquifolium<D> is an excellent
peptic bitter and tonic to the gastric function, and is, therefore, a drug
of much value in atonic dyspepsia, with hepatic torpor. Upon the mucosa
its effects are like those of goldenseal, controlling catarrhal outpouring
and erosion of tissue." (Felter 1922)

His older medical terminology may be translated to say that Oregon grape
is effective in digestive complaints that require a bitter tonic, sluggish
liver complaints, and chronic mucous membrane problems. If we put these
two doctors' opinions together, Oregon grape alone could take the place
of the echinacea-goldenseal preparations so common now in health food stores.
Oregon grape is especially famous as a treatment for chronic skin conditions.

Table Species and common names of Oregon grape

Species

Mahonia (Berberis) aquifolium

M. nervosa

M. repens

M. pinnata

Common names

Barberry

Creeping barberry

Mahonia

Mountain holly

Odostemon

Yerba de Sangre

(Source: Moore 1993)

An herbalist's testimony

Northwest herbalist Howie Brounstein has used Oregon grape as a substitute
for echinacea and goldenseal, and his experienceverifies the opinion of
the Eclectic physicians that it is a worthy replacement for either. He
has used it for intestinal and other bacterial infections for more than
ten years. He considers it in cases that might otherwise call for a broad-spectrum
antibiotic, although he does not consider Oregon grape to be an antibiotic
itself. Brounstein uses internal doses of the tincture in doses of forty-five
to sixty drops three or four times a day. If it is going to work, he says,
there should be marked improvement within twenty-four hours. His observations
are recorded as follows:.

Antibiotic resistant ear infections: Every case I have treated
has cleared up. I Usually add mullein flower oil externally to the ear.

Bacterial infection moving inward: Excellent results

Abscessed tooth: Excellent results

Colds: Much better than Echinacea for the common cold. If echinacea
is the light cavalry, Berberis is the heavy artillery.

Bronchitis Good results

Bladder infections Mixed results, I generally use other herbs
first and move to Berberis in more stubborn cases.

This plant contains a number of alkaloids besides the more famous berberine.
These alkaloids, some of which are found in other berberine-containing
plants, may contribute to the sort of broad-spectrum effects that Brounstein
notes.

Alkaloids in the various species of Oregon grape root:

berberine

magnoflorine

berbamine

jatrorrhizine

canadine

oxycanthine

mahonine

oxyberberine

Yerba Mansa (Anemopsis californica<D>)

Yerba Mansa is a traditional Southwest herb which is growing in popularity
as a goldenseal substitute, primarily on the authority and advice of Southwest
herbalist Michael Moore (Moore 1989). It is one of the most-often prescribed
herbs at our clinic in Boulder, Colorado. Moore, is well-known not only
for his scholarship of the herbal scientific literature, but for knowledge
of traditional plant use and hands-on knowledge the plants he writes about.
His three volumes are among the most important herbal texts in American
history. He didn't come up with the idea of using yerba mansa as a goldenseal
substitute out of thin air. You may not have heard of this herb, but don't
underrate it because it is not as famous as goldenseal. To the traditional
residents of the desert areas where it grows, local residents consider
it among the "royalty" of the local herbs.

Yerba mansa is very different from goldenseal. It contains no berberine
or other related alkaloids, and it not a bitter tonic. It is hot and acrid,
with a warming sensation, and is astringent. It may replace goldenseal
as a mucous membrane tonic, when bitter tonics are contraindicated and
the membranes are congested.

The Eclectics were aware of its properties, but generally only those
in the Western states used it extensively. It was introduced into Eclectic
use by Dr. W.H. George of California in 1877 — about the same time as echinacea
— and remained in use by that profession until its decline in the 1930s.
The homeopathic school also used it (Boericke 1927). The chief Eclectic
indication was as a mucous membrane remedy, when there is full stuffy sensation
in the head and throat, cough with expectoration, or mucous discharges
from the bowels or urinary tract.

The eclectic uses of yerba mansa:

diarrhea

dysentery

intestinal tonic

mucous membrane tonic

nasal catarrh

respiratory tonic

skin ulcers

tuberculosis

urinary organ tonic

Don't throw out the goldenseal

The above herbs all either contain constituents in common with goldenseal,
or have been used for similar conditions. The Eclectics described several
of them as goldenseal substitutes more than seventy-five years ago. I don't
personally use them in the place of goldenseal in all conditions, however.

Try this experiment: Take some goldenseal and several of its substitutes:
I've done this with barberry, Oregon grape root, and yerba mansa, and various
mixtures of them, as tinctures. Take a dose, say a dropperfull of the tincture
or the powdered herb in a little water, and hold it in your mouth. When
I take the goldenseal, within a minute I can feel secretions moving in
my nasal mucous membranes. In a short time, I can feel stimulation in my
intestines and urinary tract membranes. I've never felt this with the goldenseal
substitutes, although a combination of Oregon grape root and yerba mansa
comes closest. The goldenseal does not have to come in contact with these
membranes to have the effect.

For this reason, I still use goldenseal in conditions where a cold,
flu, or bronchitis seems to be going deeper into the system, or becoming
complicated by a bacterial infection. In one case, a client with a chronic
dry bronchitis had been coughing up only slight amounts of clear phlegm
for several weeks. Then the discharges turned to yellow and green — a sign
of the onset of bacterial infection and the threat of pneumonia. A combination
of goldenseal and echinacea returned the phlegm to its normal clear color
within twelve hours. Goldenseal is simply the most effective and fastest
remedy for such a condition. I've consulted with two herbalists who were
suffering from a similar condition four or five days into a cold. Each
of these Southwest herbalists had tried yerba mansa for the condition,
without noticeable effect. When they used goldenseal, the got rapid results.